The latest worrying figures from the Office for National Statistics show that city-dwellers have the highest mortality rate from Covid-19, with London’s deaths at almost double the next highest regional rate. The hardest-hit local authorities are all in the capital. And the urban-rural divide in health outcomes has a long history: A new paper from the Addressing Health team reveals that sickness in cities – London in particular – was far higher in the nineteenth century than it was in smaller towns and rural areas.
The findings are based on the records of over 1,200 workers in all parts of the United Kingdom who retired from careers in the Post Office in the late nineteenth century. Only 40 per cent of them actually reached retirement age. The other 60 per cent had to retire early because of ill health. We examined the specific health reasons for early retirement and compared those across different types of places in the UK. The results are striking.
London’s postal workers were by far the most likely to retire early from ill health in the late nineteenth century, at 76 per cent, with only 24 per cent making it to retirement age (60 years old for most of the period, and 65 towards the end of the century). Other cities had high levels of early retirement, but nowhere near as high as London. In towns and rural areas, however, just over half worked until retirement age. Not only did they retire sooner, but urban postal workers also had more sickness absences than those working outside cities: Rural workers took on average 5.2 sick days a year, but in London the average was 17.7 sick days a year.
Research over the past couple of decades has already shown that life expectancy at birth was worse for Londoners in the nineteenth century (38 years in the 1850s) than for the whole of England and Wales (41 years). What’s new about the findings from the Post Office records is that we’re looking at ill health rather than death rates – and there are plenty of illnesses that don’t kill but can limit the ability to work nonetheless. There’s little information about ill health compared to what we know about causes of death, so this new evidence is especially useful for understanding people’s experiences of disease and how it affected their working lives.
Why did urban workers retire younger? Some clues can be found in the causes of early retirement. In London, the most common conditions which ended careers were associated with mental health and vision problems. Employees blamed stressful working conditions, including having to deal with enormous volumes of mail and split shifts which interfered with sleep patterns, for a wide range of symptoms described broadly as ‘nervous debility’ or ‘nervous exhaustion’. Workers in the sorting offices especially attributed their worsening eyesight to working under dim gas lighting and complained of headaches arising from the noxious fumes that were produced. The handling of mail sacks produced dust which irritated the throat and lungs. And users of the Morse telegraphy machines frequently suffered from a form of repetitive strain injury which became known as ‘telegraphists’ cramp’.
Problems with feet and other orthopaedic conditions were frequent among both urban and rural workers, perhaps because they had to walk long distances to deliver the mail in all kinds of conditions. Postal workers’ representatives repeatedly complained about this to the authorities, and one told a Parliamentary committee in 1906 that in London ‘the immense increase in the practice of sending picture post-cards has made the stair-climbing feature of duty more acute, as the occupants of flats appear to indulge largely in this form of communication’.
What we’ve found out so far tells us that understanding geography is really important in explaining different health outcomes. City crowds make the transmission of diseases like Covid-19 or tuberculosis easy. Atmospheric pollution – whether from cars and lorries today or coal-burning factories and domestic hearths in the Victorian period – damages our lungs and may well predispose us to infections. And urban deprivation brings with it higher mortality.
Alongside these factors we also have to consider workplace environments too. Jobs in the nineteenth-century Post Office often involved heavy manual labour, unhealthy shift patterns and un-ergonomic machinery in cities, and lengthy delivery rounds with exposure to the elements in the countryside.
Our sample of 1,200 postal workers is only a start, and not enough to enable us to answer a lot of the questions we still have, especially about differences in health outcomes according to gender, job or life after the Post Office. The next step is to add thousands more employees by digitising more of the Postal Museum’s records. Follow us on Twitter or contact us at email@example.com to get involved.
(About our definitions: We defined cities as places with populations above 100,000, towns as having populations between 10,000 and 100,000, and rural areas below 10,000. Retirements were examined for 1861, 1871, 1881 and 1891: census years, so we can readily investigate their household returns in future. For more on the categorisation of diseases, and to see the findings in detail, see our paper in the Journal of Historical Geography.)
Dr Doug Brown: @dhlbrown